The Dr. Fauci Of The 1918 Spanish Flu
BY: Alex Knapp, Forbes
More than a century ago, epidemiologist Dr. Thomas Tuttle
prescribed face masks and social distancing to slow the
influenza pandemic. He made a lot of enemies-but it worked.
ADVERTISEMENT IN January 1919, Washington's health
commissioner urged legislators in the state capital,
Olympia, to enforce strict measures against the spread of
the Spanish flu, which had just ended a deadly second wave
in America. Recommended restrictions included banning dances
and other social gatherings, as well as limits on how many
people could attend public meetings and how far apart they
should sit from one another. Both the city and county voted
against those measures. In response, the commissioner sought
to get the State Board of Health to enforce its police
powers against the county. Instead, he lost his job. A
public health official getting fired over unpopular social
distancing measures during a pandemic has an eerie echo
today, when business leaders and politicians are chafing
against restrictions urged by authorities to contain the
COVID-19 pandemic. But it was precisely these restrictions
that enabled Seattle and other cities in Washington to
protect themselves from the Spanish flu-and similar actions
helped Kansas abate another influenza wave in the fall of
1919. At the center of public health efforts in both states
was a practical, plainspoken, bespectacled scientist: Dr.
Thomas Dyer Tuttle, who became a powerful, if polarizing,
figure in the fight against the Spanish flu-not unlike Dr.
Anthony Fauci is perceived today, in the battle against
COVID-19. Apart from the passing physical resemblance,
both Dr. Tuttle and Dr. Fauci fought global pandemics late
in their long public health careers and the perilous balance
of science and sociology that entails. Both men attended Ivy
League medical schools. Both were commissioned officers in
the United States Public Health Service. And both had
experience fighting previous epidemics. Fauci first came to
prominence in the 1980s as the leading HIV/AIDS researcher
for Ronald Reagan and George H.W. Bush. For Tuttle, it was a
resurgence of smallpox at the turn of the 20th century.
ADVERTISEMENT Tuttle was born in Fulton, Missouri, in 1869.
He was the son of a grocer who had married into wealth-his
mother's family, according to a local history, had a home
encompassing about a quarter of a city block. He received
his bachelor's degree at local Westminster College (where
Winston Churchill would deliver his famous "Iron Curtain"
speech some 56 years after Dr. Tuttle had graduated). Tuttle
then moved to New York City in 1889 to obtain a medical
degree at what was then known as Columbia College. During
that first year of medical school, he unwittingly found
himself in the midst of one of the deadliest flu pandemics,
the so-called "Russian flu," which had killed tens of
thousands in Europe that fall and arrived in New York in
December. That flu would end up causing more than 2,500
deaths in New York before subsiding in February 1890.
Battle Ready in 1918: Soldiers under quarantine in
Washington state during the Spanish flu and Red Cross
volunteers sewing masks. (Washington State Historical
Society, Gregg Courtwright Collection) After graduating from
Columbia in 1892, Tuttle worked at New York's Mount Sinai
hospital. He later returned to Missouri, where he married
his wife, Lucile, in 1896. A few years later, the couple
moved to Montana where Tuttle pursued a medical career and
became Secretary and Executive Officer of the state's Board
of Health in 1903. It was in this role that Dr. Tuttle
first learned to value science over unpopular public
opinion. In 1909, Tuttle made headlines in local Montana
newspapers-ironically, by coming out against
quarantines-much to the consternation of the public.
Smallpox had ravaged the population in the early 1900s, but
Dr. Tuttle's reasoning behind the order was that lifting
quarantines would encourage people to vaccinate. (In 1905,
the Supreme Court case Jacobson v. Massachusetts upheld
states' authority to require smallpox vaccinations in the
interest of public health.) Tuttle and the state's Board of
Health had promoted mandatory smallpox vaccinations by
offering them free of charge and by circulating a
Tuttle-penned pamphlet touting their benefits. Those
instructions included sharp words for the anti-vaxxers of
the day: "It is the firm belief of the author that the most
effectual way to rid this country of smallpox would be to
give a few months warning, in order that all might have time
to be successfully vaccinated," Dr. Tuttle wrote. "And then
let any cases of smallpox that might appear go at large,
without disinfection, so that those who would not be
vaccinated might have the disease and be done with it. Such
a move would result in a radical 'change of heart' on the
part of many, if not all, 'anti-vaccinationists.'" In 1915,
with smallpox under control in America, Dr. Tuttle accepted
a new position as health commissioner of Washington. Three
years later, in July 1918, the Spanish flu reached the
state. The first set of infections hit the Army's Camp
Lewis, where more than 300 cases were reported. As summer
went on, the number of cases appeared to decline and the
"alarm went down," says historian Gwen Whiting. But the
numbers started to creep up again in September, and public
health officials became concerned about a second wave. The
state's Board of Health met in late September specifically
to discuss concerns over the flu, and after the meeting
Tuttle spoke to a newspaper to warn citizens that the flu
would return. Because of limitations on the state Board of
Health's authority, Dr. Tuttle wasn't able to enforce many
orders until November, says Whiting. But he did use his
position to encourage local officials to announce stringent
measures to contain the pandemic in early October. Dr.
Tuttle, who lived in Seattle, worked closely with the local
health commissioner, Dr. J.S. McBride, to manage the
trajectory of flu cases. Alarmed by hundreds of hospitalized
cases of flu in the nearby Naval training station, Tuttle
declared that the Spanish flu had arrived in the city. Both
McBride and Seattle's mayor, Ole Hanson, acted quickly in
response-taking advice from Dr. Tuttle. Thoughts and
Prayers: After closing Seattle's churches in 1918, Mayor Ole
Hanson said, "Religion which won't keep for two weeks is not
worth having." On October 5, 1918, Mayor Hanson laid out his
measures to curb the epidemic in Seattle. "He closed the
churches. He shut down public places. They even raised fines
for spitting on the sidewalk," explains Whiting. "You could
be fined if you weren't wearing a mask to get on the
streetcar. All of these strict restrictions were put into
place in Seattle. And other cities followed suit."
Meanwhile, Dr. Tuttle took to the newspapers to spread
health advice- sending letters to the press statewide,
proclaiming that the flu might be prevented from becoming
epidemic with "the earnest, conscientious and intelligent
help of every citizen of the State" following a now-familiar
set of precautions: Don't sneeze or cough in your hands,
keep away from crowds, and stay at home if you have any
symptoms. The Cold War: To warn Kansans of the perils of
another Spanish flu wave, Dr. Tuttle took his message to the
local papers. As with the COVID-19 pandemic, the response
to Spanish flu in Seattle, Spokane and other Washington
cities had parallels across the country. New York, St. Louis
and Los Angeles also saw success through the use of austere
public health measures, while cities such as San Francisco
and Philadelphia were less restrictive and saw increased flu
deaths as a result. But those higher mortality rates are
also due, in part, because the severe measures simply
weren't popular. Even in Seattle, "there was a lot of
protest" over public health restrictions, says Whiting.
Although Dr. Tuttle gave advice to local authorities behind
the scenes, he tended to act more pragmatically as the flu
progressed. He never issued a statewide lockdown, for
example, because the U.S. Surgeon General had advised
against it. He also lifted a statewide order to wear masks
in public after Armistice Day in November 1918-partly
because citizens weren't adhering to it anyway. The end of
World War I also saw an easing of health restrictions in
Seattle. But it came at a cost. In early December, the flu
came back. Although this time, rather than ban public
gatherings, people exposed to influenza were ordered to
remain in their homes. That month, Dr. Tuttle traveled to
Chicago for a national conference of the American Public
Health Association dedicated to combating the disease, and
that meeting appears to have hardened his resolve to be even
more aggressive. Tuttle may have been pragmatic earlier in
the epidemic, but he began to be more publicly exasperated
at the lack of enforcement of public health laws. Tuttle's
frustrations pepper reports he prepared after this period,
and he was later described by a contemporary as belonging
"to that old-fashioned school of citizens who believe laws
and regulations were made to be enforced." Such a resolute
attitude likely cut short his position as health
commissioner in Washington. The restrictions Dr. Tuttle was
trying to enforce were "pretty controversial ideas at the
time," says Whiting, "so he made a lot of enemies." After
being ousted from Washington, Dr. Tuttle moved to Kansas,
where he accepted a position as Epidemiologist for the State
Board of Health. In that role, he began to fear another
influenza epidemic would appear in the state by the fall of
1919 and minced no words in encouraging the public to follow
public health guidelines. ADVERTISEMENT "Those who buried
their dear ones last winter should certainly lend every
effort to prevent others facing a similar loss," Dr. Tuttle
wrote in a Topeka paper on September 11, 1919. He also wrote
letters to county health commissioners, urging strict
enforcement of quarantines. Though not considered part of
the Spanish flu pandemic, Kansas did see a high level of
influenza cases in the winter of 1919-20, and Dr. Tuttle did
his best to ensure local communities were prepared. Despite
the work he had done to save lives in Washington and Kansas,
it's clear that Tuttle was pessimistic about his country's
ability to prepare for the next pandemic. "As a matter of
fact, we know about as little with regard to the etiology
and epidemiology of influenza today as we knew two years
ago," he wrote in one report, "and owing to the inclination
of our government (city, county, state and national) to
provide funds for operating only when sickness is present,
and to absolutely cut off any support whatsoever for the
study of the epidemiology of the disease after an epidemic
has passed, renders it very probable that we will meet our
next epidemic (probably 20 or 30 years hence) with as little
knowledge of the true nature of the disease as we had when
we confronted the epidemic in the fall of 1918."
Two years later, Tuttle resigned his role in Kansas, citing
a need for a bigger salary so he could afford to pay for his
son's college education. In its biennial report, the Board
of Health lamented his departure and urged that the
legislature increase the salary for the role in order to
secure "a man of the quality and training Kansas desires."
His next job took Dr. Tuttle back to Montana to start a
veterans hospital at Fort Harrison, which still exists
today. He later moved to Chicago to practice medicine. In
1933, he and his wife retired to San Diego, where Dr. Tuttle
spent his golden years gardening-on the 1940 census, he
wryly noted his occupation as "orchidist" with an income of
zero-before passing away in 1942.
Second Opinions: Like Dr. Tuttle's stringent measures, Dr.
Fauci's guidelines haven't always been popular. (Jeremy
Hogan/SOPA Images/LightRocket via Getty Images)
Nearly 80 years after Dr. Tuttle's death, his legacy in
fighting pandemics lives on, which might have come as a
surprise to him, given the pessimism he expressed in his
lifetime. In 2009, a group of researchers wrote a paper
<https://journals.sagepub.com/doi/pdf/10.1177/00333549091240
0105> comparing existing CDC guidelines on managing
pandemics to those developed during the Spanish flu. The
paper noted that of all the recommendations, measures Dr.
Tuttle promoted-encouraging the closing of public spaces and
social distancing-were still relevant in fighting epidemics
today. The report even cited findings from the 1918 December
meeting Dr. Tuttle attended before insisting on the
draconian health measures that got him fired.
One of the coauthors of that 2009 paper?
Dr. Anthony Fauci.
Ann Foxworth
What a very true article thanks for sharing.
On Apr 28, 2020, at 4:48 PM, Carolyn 4carolyna@windstream.net wrote:
The Dr. Fauci Of The 1918 Spanish Flu
BY: Alex Knapp, Forbes
More than a century ago, epidemiologist Dr. Thomas Tuttle
prescribed face masks and social distancing to slow the
influenza pandemic. He made a lot of enemies-but it worked.
ADVERTISEMENT IN January 1919, Washington's health
commissioner urged legislators in the state capital,
Olympia, to enforce strict measures against the spread of
the Spanish flu, which had just ended a deadly second wave
in America. Recommended restrictions included banning dances
and other social gatherings, as well as limits on how many
people could attend public meetings and how far apart they
should sit from one another. Both the city and county voted
against those measures. In response, the commissioner sought
to get the State Board of Health to enforce its police
powers against the county. Instead, he lost his job. A
public health official getting fired over unpopular social
distancing measures during a pandemic has an eerie echo
today, when business leaders and politicians are chafing
against restrictions urged by authorities to contain the
COVID-19 pandemic. But it was precisely these restrictions
that enabled Seattle and other cities in Washington to
protect themselves from the Spanish flu-and similar actions
helped Kansas abate another influenza wave in the fall of
1919. At the center of public health efforts in both states
was a practical, plainspoken, bespectacled scientist: Dr.
Thomas Dyer Tuttle, who became a powerful, if polarizing,
figure in the fight against the Spanish flu-not unlike Dr.
Anthony Fauci is perceived today, in the battle against
COVID-19. Apart from the passing physical resemblance,
both Dr. Tuttle and Dr. Fauci fought global pandemics late
in their long public health careers and the perilous balance
of science and sociology that entails. Both men attended Ivy
League medical schools. Both were commissioned officers in
the United States Public Health Service. And both had
experience fighting previous epidemics. Fauci first came to
prominence in the 1980s as the leading HIV/AIDS researcher
for Ronald Reagan and George H.W. Bush. For Tuttle, it was a
resurgence of smallpox at the turn of the 20th century.
ADVERTISEMENT Tuttle was born in Fulton, Missouri, in 1869.
He was the son of a grocer who had married into wealth-his
mother's family, according to a local history, had a home
encompassing about a quarter of a city block. He received
his bachelor's degree at local Westminster College (where
Winston Churchill would deliver his famous "Iron Curtain"
speech some 56 years after Dr. Tuttle had graduated). Tuttle
then moved to New York City in 1889 to obtain a medical
degree at what was then known as Columbia College. During
that first year of medical school, he unwittingly found
himself in the midst of one of the deadliest flu pandemics,
the so-called "Russian flu," which had killed tens of
thousands in Europe that fall and arrived in New York in
December. That flu would end up causing more than 2,500
deaths in New York before subsiding in February 1890.
Battle Ready in 1918: Soldiers under quarantine in
Washington state during the Spanish flu and Red Cross
volunteers sewing masks. (Washington State Historical
Society, Gregg Courtwright Collection) After graduating from
Columbia in 1892, Tuttle worked at New York's Mount Sinai
hospital. He later returned to Missouri, where he married
his wife, Lucile, in 1896. A few years later, the couple
moved to Montana where Tuttle pursued a medical career and
became Secretary and Executive Officer of the state's Board
of Health in 1903. It was in this role that Dr. Tuttle
first learned to value science over unpopular public
opinion. In 1909, Tuttle made headlines in local Montana
newspapers-ironically, by coming out against
quarantines-much to the consternation of the public.
Smallpox had ravaged the population in the early 1900s, but
Dr. Tuttle's reasoning behind the order was that lifting
quarantines would encourage people to vaccinate. (In 1905,
the Supreme Court case Jacobson v. Massachusetts upheld
states' authority to require smallpox vaccinations in the
interest of public health.) Tuttle and the state's Board of
Health had promoted mandatory smallpox vaccinations by
offering them free of charge and by circulating a
Tuttle-penned pamphlet touting their benefits. Those
instructions included sharp words for the anti-vaxxers of
the day: "It is the firm belief of the author that the most
effectual way to rid this country of smallpox would be to
give a few months warning, in order that all might have time
to be successfully vaccinated," Dr. Tuttle wrote. "And then
let any cases of smallpox that might appear go at large,
without disinfection, so that those who would not be
vaccinated might have the disease and be done with it. Such
a move would result in a radical 'change of heart' on the
part of many, if not all, 'anti-vaccinationists.'" In 1915,
with smallpox under control in America, Dr. Tuttle accepted
a new position as health commissioner of Washington. Three
years later, in July 1918, the Spanish flu reached the
state. The first set of infections hit the Army's Camp
Lewis, where more than 300 cases were reported. As summer
went on, the number of cases appeared to decline and the
"alarm went down," says historian Gwen Whiting. But the
numbers started to creep up again in September, and public
health officials became concerned about a second wave. The
state's Board of Health met in late September specifically
to discuss concerns over the flu, and after the meeting
Tuttle spoke to a newspaper to warn citizens that the flu
would return. Because of limitations on the state Board of
Health's authority, Dr. Tuttle wasn't able to enforce many
orders until November, says Whiting. But he did use his
position to encourage local officials to announce stringent
measures to contain the pandemic in early October. Dr.
Tuttle, who lived in Seattle, worked closely with the local
health commissioner, Dr. J.S. McBride, to manage the
trajectory of flu cases. Alarmed by hundreds of hospitalized
cases of flu in the nearby Naval training station, Tuttle
declared that the Spanish flu had arrived in the city. Both
McBride and Seattle's mayor, Ole Hanson, acted quickly in
response-taking advice from Dr. Tuttle. Thoughts and
Prayers: After closing Seattle's churches in 1918, Mayor Ole
Hanson said, "Religion which won't keep for two weeks is not
worth having." On October 5, 1918, Mayor Hanson laid out his
measures to curb the epidemic in Seattle. "He closed the
churches. He shut down public places. They even raised fines
for spitting on the sidewalk," explains Whiting. "You could
be fined if you weren't wearing a mask to get on the
streetcar. All of these strict restrictions were put into
place in Seattle. And other cities followed suit."
Meanwhile, Dr. Tuttle took to the newspapers to spread
health advice- sending letters to the press statewide,
proclaiming that the flu might be prevented from becoming
epidemic with "the earnest, conscientious and intelligent
help of every citizen of the State" following a now-familiar
set of precautions: Don't sneeze or cough in your hands,
keep away from crowds, and stay at home if you have any
symptoms. The Cold War: To warn Kansans of the perils of
another Spanish flu wave, Dr. Tuttle took his message to the
local papers. As with the COVID-19 pandemic, the response
to Spanish flu in Seattle, Spokane and other Washington
cities had parallels across the country. New York, St. Louis
and Los Angeles also saw success through the use of austere
public health measures, while cities such as San Francisco
and Philadelphia were less restrictive and saw increased flu
deaths as a result. But those higher mortality rates are
also due, in part, because the severe measures simply
weren't popular. Even in Seattle, "there was a lot of
protest" over public health restrictions, says Whiting.
Although Dr. Tuttle gave advice to local authorities behind
the scenes, he tended to act more pragmatically as the flu
progressed. He never issued a statewide lockdown, for
example, because the U.S. Surgeon General had advised
against it. He also lifted a statewide order to wear masks
in public after Armistice Day in November 1918-partly
because citizens weren't adhering to it anyway. The end of
World War I also saw an easing of health restrictions in
Seattle. But it came at a cost. In early December, the flu
came back. Although this time, rather than ban public
gatherings, people exposed to influenza were ordered to
remain in their homes. That month, Dr. Tuttle traveled to
Chicago for a national conference of the American Public
Health Association dedicated to combating the disease, and
that meeting appears to have hardened his resolve to be even
more aggressive. Tuttle may have been pragmatic earlier in
the epidemic, but he began to be more publicly exasperated
at the lack of enforcement of public health laws. Tuttle's
frustrations pepper reports he prepared after this period,
and he was later described by a contemporary as belonging
"to that old-fashioned school of citizens who believe laws
and regulations were made to be enforced." Such a resolute
attitude likely cut short his position as health
commissioner in Washington. The restrictions Dr. Tuttle was
trying to enforce were "pretty controversial ideas at the
time," says Whiting, "so he made a lot of enemies." After
being ousted from Washington, Dr. Tuttle moved to Kansas,
where he accepted a position as Epidemiologist for the State
Board of Health. In that role, he began to fear another
influenza epidemic would appear in the state by the fall of
1919 and minced no words in encouraging the public to follow
public health guidelines. ADVERTISEMENT "Those who buried
their dear ones last winter should certainly lend every
effort to prevent others facing a similar loss," Dr. Tuttle
wrote in a Topeka paper on September 11, 1919. He also wrote
letters to county health commissioners, urging strict
enforcement of quarantines. Though not considered part of
the Spanish flu pandemic, Kansas did see a high level of
influenza cases in the winter of 1919-20, and Dr. Tuttle did
his best to ensure local communities were prepared. Despite
the work he had done to save lives in Washington and Kansas,
it's clear that Tuttle was pessimistic about his country's
ability to prepare for the next pandemic. "As a matter of
fact, we know about as little with regard to the etiology
and epidemiology of influenza today as we knew two years
ago," he wrote in one report, "and owing to the inclination
of our government (city, county, state and national) to
provide funds for operating only when sickness is present,
and to absolutely cut off any support whatsoever for the
study of the epidemiology of the disease after an epidemic
has passed, renders it very probable that we will meet our
next epidemic (probably 20 or 30 years hence) with as little
knowledge of the true nature of the disease as we had when
we confronted the epidemic in the fall of 1918."
Two years later, Tuttle resigned his role in Kansas, citing
a need for a bigger salary so he could afford to pay for his
son's college education. In its biennial report, the Board
of Health lamented his departure and urged that the
legislature increase the salary for the role in order to
secure "a man of the quality and training Kansas desires."
His next job took Dr. Tuttle back to Montana to start a
veterans hospital at Fort Harrison, which still exists
today. He later moved to Chicago to practice medicine. In
1933, he and his wife retired to San Diego, where Dr. Tuttle
spent his golden years gardening-on the 1940 census, he
wryly noted his occupation as "orchidist" with an income of
zero-before passing away in 1942.
Second Opinions: Like Dr. Tuttle's stringent measures, Dr.
Fauci's guidelines haven't always been popular. (Jeremy
Hogan/SOPA Images/LightRocket via Getty Images)
Nearly 80 years after Dr. Tuttle's death, his legacy in
fighting pandemics lives on, which might have come as a
surprise to him, given the pessimism he expressed in his
lifetime. In 2009, a group of researchers wrote a paper
<https://journals.sagepub.com/doi/pdf/10.1177/00333549091240
0105> comparing existing CDC guidelines on managing
pandemics to those developed during the Spanish flu. The
paper noted that of all the recommendations, measures Dr.
Tuttle promoted-encouraging the closing of public spaces and
social distancing-were still relevant in fighting epidemics
today. The report even cited findings from the 1918 December
meeting Dr. Tuttle attended before insisting on the
draconian health measures that got him fired.
One of the coauthors of that 2009 paper?
Dr. Anthony Fauci.
Ann Foxworth
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